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# Diclofenac Tablets
## Overview
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) that inhibits prostaglandin synthesis, providing analgesic, anti-inflammatory, and antipyretic effects.
## Primary Indications
* Pain management (e.g., acute pain, osteoarthritis, rheumatoid arthritis, ankylosing spondylitis)
* Inflammation reduction
## Adult Dosing
* **Acute Pain:** 50 mg every 8 hours as needed. Maximum daily dose: 150 mg.
* **Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spondylitis:** 50 mg 2-3 times daily or 75 mg twice daily. Maximum daily dose: 150 mg.
* **Extended-release formulations:** Dosing varies by product, typically once or twice daily. Refer to specific product labeling.
## Pediatric Dosing
Dosing is not well-established for all indications in pediatrics.
* **Analgesia/Antipyresis:** 1-3 mg/kg/day divided into 3-4 doses. Do not exceed adult maximum doses. Use with caution and close monitoring.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution; dosage reduction may be considered in mild to moderate impairment. Avoid in severe hepatic impairment.
* **Renal Impairment:** Use with caution. Monitor renal function. Avoid in severe renal impairment.
## Contraindications
* Hypersensitivity to diclofenac, aspirin, or other NSAIDs.
* History of bronchospasm, asthma, rhinitis, or urticaria induced by aspirin or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal bleeding or ulceration.
* Severe hepatic or renal impairment.
* Third trimester of pregnancy.
## Adverse Effects
* **Common:** Gastrointestinal upset (dyspepsia, nausea, diarrhea), dizziness, headache.
* **Serious:** Cardiovascular thrombotic events (MI, stroke), gastrointestinal perforation/bleeding, hepatotoxicity, renal toxicity, hypersensitivity reactions, Stevens-Johnson syndrome/TEN, hypertension.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration/bleeding.
* **SSRIs/SNRIs:** Increased risk of GI bleeding.
* **ACE inhibitors/ARBs/Diuretics:** Reduced antihypertensive effect and increased risk of renal impairment.
* **Lithium/Methotrexate:** Increased serum levels and toxicity.
## Monitoring
* **Baseline and periodic:** Renal function (BUN, creatinine), liver function tests (ALT, AST), complete blood count (CBC).
* Monitor for signs and symptoms of GI bleeding, cardiovascular events, and hypersensitivity reactions.
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Administer with food or milk to reduce gastrointestinal upset.
* Consider gastroprotective agents (e.g., PPIs) in patients at increased risk for GI complications.
* Avoid concomitant use with other NSAIDs.
* Be aware of the risk of "NSAID-exacerbated respiratory disease" in patients with asthma and nasal polyps.
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*This information is intended for healthcare professionals and does not substitute for current prescribing information. Always verify drug information with the official product labeling and institutional protocols.*
